Diagnostic Yield of Opportunistic Upper Gastrointestinal Endoscopy During Elective Colonoscopy in Asymptomatic Patients: A Retrospective Cross-Sectional Study

BackgroundOpportunistic upper gastrointestinal endoscopy (EGD) during elective colonoscopy has been proposed as a strategy for detecting upper gastrointestinal abnormalities in asymptomatic individuals.However, evidence regarding its diagnostic yield and clinical relevance remains limited, particularly in Western populations.This study aimed to evaluate the diagnostic yield of opportunistic EGD performed during elective colonoscopy in asymptomatic patients. MethodsThis retrospective cross-sectional study included asymptomatic patients who underwent opportunistic EGD during elective colonoscopy at a tertiary endoscopy center in Brazil between March 2023 and March 2025.The primary outcome was the proportion of patients with at least one clinically significant finding, including selected premalignant and malignant lesions, Helicobacter pylori (H.pylori) infection, and other potentially relevant upper gastrointestinal abnormalities.Endoscopic and histopathological findings were retrospectively reviewed.Descriptive statistical analyses were performed, and diagnostic yield was reported with a 95% confidence interval (CI).Changes in clinical management were not assessed. ResultsA total of 421 asymptomatic patients were included, of whom 269 (63.9%) were female; the mean age was 58.4 years.At least one clinically significant finding was identified in 188 patients (44.7%; 95% CI: 39.8%-49.5%).Gastritis was identified in 293 patients (69.6%), and H. pylori infection was detected in 102 (24.2%).Premalignant gastric findings included intestinal metaplasia in 45 patients (10.7%), gastric atrophy in 27 (6.4%),and low-grade dysplasia in 2 (0.5%).Gastric carcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma were each diagnosed in one patient (0.2%).Additional findings included gastric polyps in 140 patients (33.3%), esophagitis in 134 (31.8%), bulboduodenitis in 26 (6.2%), and Barrett's esophagus in 3 (0.7%). ConclusionsOpportunistic EGD performed during elective colonoscopy demonstrated a substantial diagnostic yield in asymptomatic patients, including the detection of premalignant and malignant upper gastrointestinal lesions.However, the absence of systematic follow-up and a comparison group precludes conclusions regarding actual changes in clinical management or improvements in patient outcomes.Prospective comparative studies incorporating longitudinal follow-up, procedural safety, and economic evaluation are needed to determine the clinical value of this strategy.